Self Swab HPV Testing Gains Approval In New Guidelines

For millions of women across the United States, cervical cancer screening has long been synonymous with the uncomfortable and often dreaded Pap smear. Now, a significant shift is underway, as new guidelines from the American Cancer Society (ACS) endorse self-collection of vaginal specimens for human papillomavirus (HPV) testing—a move that could transform how women approach cervical cancer prevention.

The ACS published its updated cervical cancer screening recommendations on December 4, 2025, marking the first time the organization has formally supported self-collected HPV testing in clinical settings for average-risk individuals aged 25 to 65. According to NPR, this change means that, for many, the days of mandatory speculum exams may be numbered—at least for those who meet the new criteria.

Self-collection is now considered a safe and effective alternative to the traditional Pap smear, provided it’s done using FDA-approved kits and under the guidance of a healthcare provider. The ACS guidelines emphasize that the option is available for average-risk women—those without conditions such as HIV, immunosuppression, prior cervical cancer, or in utero exposure to diethylstilbestrol (DES). For these higher-risk groups, clinician-collected samples and additional cytology testing remain necessary, since cytology cannot be performed on self-collected specimens, as highlighted by Healthline.

Why the change? The answer lies in both science and equity. Over 90% of cervical cancer cases are caused by HPV, and HPV testing has proven to be more sensitive than the Pap smear. Dr. Rebecca Perkins, an OB/GYN at Tufts University and lead author of the new ACS guidelines, told NPR, “HPV testing detects 90% to 95% of pre-cancerous abnormalities,” compared to only 70% to 80% for Pap smears. This means that HPV testing is not just less invasive for many patients—it’s also more likely to catch the earliest signs of trouble.

The ACS decision follows recent FDA approvals of several HPV tests and collection devices for use in clinical settings, as well as one at-home kit. Current options for self-collection in clinics include the Roche cobas HPV test with FLOQSwab or Evalyn Brush, BD Onclarity HPV test with FLOQSwab, and Abbott Alinity m with Evalyn Brush or Qvintip swab. For those wishing to collect samples at home, the Teal Wand—approved in May 2025—is the only FDA-sanctioned device, but it’s available exclusively through a proprietary telehealth service called Teal Health, which charges $99 plus insurance billing. As NPR notes, this means most patients still need to visit a clinic to access self-swabbing, though many find the process far less distressing than a traditional pelvic exam.

Accessibility is at the heart of the ACS’s new approach. The guidelines are designed to remove barriers that have kept many women from regular screening. According to Dr. Jennifer Lincoln, a board-certified OB-GYN and women’s health advocate, “Over 1 in 4 U.S. females are behind on screening, with 32% citing discomfort as a barrier.” Lincoln, who was not involved in drafting the new guidelines, explained to Healthline that self-collection is particularly beneficial for women in rural areas, those with limited access to healthcare, trauma survivors, and anyone uncomfortable with speculum exams. She added, “Multiple testing options also increase the likelihood that patients will actually get screened by meeting them where they are.”

Indeed, the stakes are high. About one-quarter of U.S. cervical cancer cases occur in women over 65, with mortality rates twice as high as those seen in younger women—a troubling statistic linked to inadequate screening before age 65. The ACS has responded by tightening the exit criteria for screening: average-risk women should now have negative primary HPV tests (or negative co-tests) at both age 60 and 65 before they can safely stop screening. Alternatively, three consecutive negative Pap tests—with the final one at age 65—are also deemed acceptable. For those using self-collected HPV testing, the recommended interval for repeat screening after a negative result is every three years, compared to five years for clinician-collected samples. This shorter interval, described by the ACS as a “margin of safety,” allows time for more data on the long-term performance of self-collection to accumulate.

But there are still hurdles to clear. Insurance coverage for HPV-only testing remains limited, largely because the U.S. Preventive Services Task Force (USPSTF) has not yet updated its recommendations to match the ACS’s. As Dr. Perkins explained to NPR, “Many insurers only pay for what the USPSTF recommends.” The USPSTF is currently reviewing its guidelines, and experts expect changes to come, but for now, some patients may find themselves paying out of pocket for the most advanced screening options.

There’s also the matter of logistics. While at-home self-swabbing is a promising development, it’s not yet widely accessible. The Teal Wand, the only FDA-approved at-home kit, can only be ordered through Teal Health’s telehealth platform, and primary care doctors cannot yet prescribe it directly. Transportation and sample stability remain concerns, especially in rural or hot regions where temperature fluctuations could affect the integrity of mailed specimens. Dr. Perkins illustrated the challenge: “Imagine you have someone in rural Texas in July [who] does their self-swab, sticks it in the mailbox. The mailbox now hits 200 degrees.” For now, self-swabbing in a clinic restroom, where samples can be quickly transported to a lab, is a more reliable option for most.

Despite these limitations, the new guidelines are widely seen as a step forward. Dr. Mara Gordon, a family physician in Camden, New Jersey, wrote in NPR that while Pap smears are “not fun” and can be “deeply upsetting for people who’ve experienced sexual or medical trauma,” the self-swab option provides a less invasive and more empowering alternative. “It can be less painful and it can give the patient a sense of control,” she observed.

Ryan Kahn, MD, a gynecologic oncologist at Baptist Health Miami Cancer Institute, emphasized to Healthline that while self-collection is now an option, it does require more frequent screening than clinician-collected samples. “Patients need to understand that they now have the option to collect their own vaginal specimen for HPV testing at home or in a clinical setting,” he said. “But this requires more frequent screening than traditional clinician-collected samples.” Kahn also noted that, for now, clinician-collected specimens remain the preferred method, and patients should be aware of the new, more stringent criteria for stopping screening.

For patients and providers alike, the ACS’s updated recommendations offer a blend of innovation and pragmatism. By expanding the menu of screening options, simplifying exit criteria, and focusing on evidence-based safety, the guidelines aim to boost participation and reduce deaths from a highly preventable cancer. As more insurance plans and public health bodies catch up with the science, the hope is that these changes will make cervical cancer screening less of a chore—and more of a routine, life-saving checkup.